失独女性IVF-ET妊娠结局的病例对照研究

Pregnancy outcome of IVF-ET in women bereaved of their only child:a matched case-control study

目的比较失独家庭与非失独家庭接受IVF-ET助孕的妊娠结局,以期为接受助孕的失独家庭及临床医生提供相关数据。方法回顾性分析2013年12月至2020年6月于西北妇女儿童医院生殖中心接受IVF-ET治疗的失独家庭患者临床资料(失独组),并将女方年龄、男方年龄以及至少生产过一个孩子作为匹配因素,按照1∶1配对,选取同期同年龄段进行助孕治疗的非失独家庭患者作为对照组。共纳入新鲜促排卵956周期(失独组:478周期,病例对照组:478周期)。比较两组患者的临床一般资料和促排卵情况,并分别比较两组患者新鲜移植周期和冻融胚胎移植(FET)周期的妊娠结局。结果临床基本资料的比较中,失独组患者的不孕年限[(2.49±3.09)年vs.(3.69±4.16)年]、分娩两次人数占比(3.14%vs.10.04%)显著低于对照组(P<0.05),而以卵巢储备功能下降原因接受助孕占比(39.75%vs.27.62%)显著高于对照组(P<0.05);两组间的体质量指数(BMI)、男女两方年龄、男方精液参数以及不孕原因等均无统计学差异(P>0.05)。促排卵情况比较中,除了失独组的优胚数[(0.63±1.32)个vs.(0.79±1.58)个]显著低于对照组(P<0.05),其他促排卵结局指标均无统计学差异(P>0.05)。两组新鲜胚胎移植及FET周期的生化妊娠率、临床妊娠率、早期妊娠丢失率、活产率均无显著性差异(P>0.05),两组之间的累计活产率亦无统计学差异。结论对于失独患者,经过政府支持以及医院建立绿色就诊通道等支持,可以与同期同年龄段患者获得类似的助孕结局。

Objective:To investigate the pregnancy outcome of IVF-ET between families with and without loss of their only child,in order to provide relevant data for families bereaved of only child receiving IVF-ET.Methods:The clinical data of patients with loss of their only child and received IVF-ET treatment(loss of only child group)in the Reproductive Center of Northwest Women and Children’s Hospital from December 2013 to June 2020 were retrospectively analyzed.Female age,male age and delivered at least one child were used as matching factors.According to 1∶1 matching,the patients without loss of their only child and underwent IVF-ET treatment in the same age group in the same period were selected as the control group.A total of 956 fresh controlled ovarian hyperstimulation(COH)cycles were enrolled,478 cycles for each group.The general clinical data and ovulation induction status,and the pregnancy outcomes of fresh transfer cycle and frozen-thawed embryo transfer(FET)cycle were compared between the two groups Results:In the comparison of clinical data,the infertile duration[(2.49±3.09)vs.(3.69±4.16)]and proportion of two deliveries(3.14%vs.10.04%)in the loss of only child group were significantly lower than those in the control group(P<0.05),while the percent of women who received assistant pregnancy due to decrease of ovarian reserve function was significantly higher than that in the control group(39.75%vs.27.62%,P<0.05).There was no significant difference in other clinical baseline indicators such as BMI,age of both sexes,parameters of male semen and other causes of infertility(P>0.05).In the comparison of ovulation induction status,the number of good-quality embryos in the loss of only child group was significantly lower than that in the control group[(0.63±1.32)vs.(0.79±1.58),P<0.05],no significant differences were found in other indicators(P>0.05).There were no significant differences in biochemical pregnancy rate,clinical pregnancy rate,early pregnancy loss rate and live birth rate in fresh transfer and FET cycles between the groups(P>0.05).There was also no significant difference in cumulative live birth rate between two groups(P>0.05).Conclusions:For women loss their only child,with the support of the government and hospital,similar pregnancy outcomes can be achieved compared with patients without loss their only child.